Mascorro v. Cigna Health and Life Insurance Co.

YAIDILH Y GUZMAN DE MASCORRO Plaintiff,v.CIGNA HEALTH AND LIFE INSURANCE COMPANY; dba LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendants.

ORDER

NELVA
GONZALES RAMOS UNITED STATES DISTRICT JUDGE

After
the death of her husband, Plaintiff Yaidilh Y. Guzman de
Mascorro filed this action against CIGNA Health and Life
Insurance Company d/b/a Life Insurance Company of North
America (CIGNA), seeking accidental death benefits allegedly
due from two employer-based life insurance policies, along
with damages for the company's failure to timely pay her
claim. In her original petition filed in state court, she
alleged only state law claims of breach of contract,
deceptive trade practices, and violations of the Texas
Insurance Code. D.E. 1-3.

CIGNA
removed the case to this Court and filed its Motion to
Dismiss (D.E. 9) alleging preemption of all of the state law
claims under the Employee Retirement Income Security Act of
1974 (ERISA), 29 U.S.C. § 1001, et seq. Plaintiff
responded, contending that the policies are not governed by
ERISA and thus ERISA preemption does not apply. Additionally,
Plaintiff filed a Motion for Leave to File First Amended
Petition (D.E. 13), continuing to allege her state law claims
and seeking to add an alternative claim for policy benefits
under 29 U.S.C. § 1132(a)(1)(B). For the reasons set out
below, the Court DENIES the motion to dismiss the state law
claims and GRANTS Plaintiff's motion for leave to file an
amended complaint.

STANDARD
OF REVIEW

The
test of pleadings under Rule 12(b)(6) is devised to balance a
party's right to redress against the interests of all
parties and the court in minimizing expenditure of time,
money, and resources devoted to meritless claims. Bell
Atlantic Corp. v. Twombly, 550 U.S. 544, 558 (2007).
Federal Rule of Civil Procedure 8(a)(2) requires only
“a short and plain statement of the claim showing that
the pleader is entitled to relief.” Furthermore,
“[p]leadings must be construed so as to do
justice.” Fed.R.Civ.P. 8(e). The Court further
construes the facts alleged in the complaint as true.

A
motion to dismiss for failure to state a claim upon which
relief can be granted can be based not only on a
plaintiff's claims but on matters that support an
affirmative defense, such as limitations or preemption.
E.g., Adobbati v. Guardian Life, 213 F.3d
638 (5th Cir. 2000) (evaluating ERISA preemption in 12(b)(6)
context). Even if some allegations support a claim, if other
allegations negate the claim on its face, then the pleading
does not survive the 12(b)(6) review.

A complaint is subject to dismissal for failure to state a
claim if the allegations, taken as true, show the plaintiff
is not entitled to relief. If the allegations, for example,
show that relief is barred by the applicable statute of
limitations, the complaint is subject to dismissal for
failure to state a claim; that does not make the statute of
limitations any less an affirmative defense, see
Fed. Rule Civ. Proc. 8(c). Whether a particular ground for
opposing a claim may be the basis for dismissal for failure
to state a claim depends on whether the allegations in the
complaint suffice to establish that ground, not on the nature
of the ground in the abstract.

Plaintiff
objects to the Court's consideration of the group
accident policies (D.E. 9-1, 9-2), which are attached to the
motion to dismiss. Yet these are the same policies on which
she has based this action, referring to them by their policy
numbers in her pleading. D.E. 1-3, p. 3.

In a
Federal Rule of Civil Procedure 12(b)(6) context, the Court
may consider: (a) documents attached to the complaint or
identified as central to the claims made therein; (b)
documents attached to the motion to dismiss that are
referenced in the complaint; and (c) documents that are
subject to judicial notice as public record. Funk v.
Stryker Corp., 631 F.3d 777, 783 (5th Cir. 2011);
Collins v. Morgan Stanley Dean Witter, 224 F.3d 496,
498-99 (5th Cir. 2000). Therefore, the Court may consider the
policies CIGNA submitted without converting the motion to a
summary judgment motion under Rule 56.

B.
Whether the Policies are Governed by ERISA is a Fact
Question

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Whether
there is an ERISA plan is a question of fact when there is
conflicting evidence. Shearer v. Sw. Serv. Life Ins.
Co., 516 F.3d 276, 278 (5th Cir. 2008). ERISA
qualification is demonstrated by showing: (1) the plan
exists; (2) the plan falls outside the safe harbor exclusion
because, in this case, the employer contributes to the plan;
and (3) the plan is established by the employer for the
purpose of providing benefits to its employees. McNeil v.
Time Ins. Co., 205 F.3d 179, 189 (5th Cir. 2000);
Meredith v. TimeIns. Co., 980 F.2d 352,
355 (5th Cir. 1993). The purchase of insurance, while
constituting substantial evidence of an ERISA plan, is not
...

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